|Title:||Tonsillectomy, hot against cold dissection : a prospective, randomized, double-blind clinical trial|
|Subject:||Hong Kong Polytechnic University -- Dissertations|
|Department:||School of Nursing|
|Pages:||viii, 65 leaves : ill. (some col.) ; 30 cm|
|Abstract:||Objective: To evaluate hot tonsillectomy with Colorado microdissection needle by comparing it with traditional cold dissection tonsillectomy Design: A prospective randomized double-blind trial. Patients: 81 consecutive patients undergoing tonsillectomy for chronic tonsillitis, tonsillar hypertrophy or obstructive sleep apnoea. Outcome measures: Operative time, intra-operative blood loss, daily postoperative pain, postoperative bleeding, ability to eat solid food, eschar level, length of hospital stay and patient's satisfaction level. Methods: Patients were randomized into hot and cold tonsillectomy groups. Operative time and blood loss were measured by nurse. Pain was recorded by patients using 0-10 numeric rating scale. Patients were evaluated by a different surgeon blinded to the surgical procedure on one and two weeks post-operation to assess the other outcome parameters. Results: Of the 81 patients (45 males, 36 females), ageing from 4 to 70 years old (mean = 19.7, SD = 14.4; median = 12, IQR = 8-28.5), there were 41 children (age < 13) and 40 adults. 40 patients received cold tonsillectomy and 41 had hot. There was no primary bleeding. Three cases of mild secondary bleeding occurred (two cold and one hot) but the difference was insignificant (p = 0.616). Mean operative time for hot group was 10.5 min (SD = 5.1; CI = +-1.59), compared with 25.5 min (SD =7.2; Cl =+-2.31) for cold group. This difference is statistically significant (Student's t-test; p =0.000; power = 1.000). Mean intra-operative blood loss for hot group was 12.3 ml (CI = +7.6) compared with 139.6 ml (CL=+- 42.6) in cold dissection. The difference is highly statistically significant (t-test; p=0.000; power = 0.999). Overall, the mean pain score varied from 6.2 on day 0 to 0.3 on day 14. There was no significant difference between hot and cold groups on post-op day 0, 1, 2, 4, 7 and 14. However, significant difference was noted between hot and cold dissection on day 3 and 5, hot dissection being more painful (Mann Whitney U test; day 3, p=0.033; day 5, p=0.0 19). There was no significant difference between hot and cold technique in other outcome measures. Conclusion: Hot tonsillectomy compares favourably with cold tonsillectomy in tens of operative time and intra-operative blood loss. There was mild increase in pain on postoperative day 3 and 5. There was no significant difference between hot and cold groups in other outcome parameters. However, there was inadequate power to detect a difference in complication rate. The data collected supported the hypotheses that outcomes of hot dissection by Colorado needle fair equally with that of cold dissection.|
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